Provider Demographics
NPI:1699162156
Name:BLACKBURN-GRIFFIN, SHARON ELIZABETH (MSSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ELIZABETH
Last Name:BLACKBURN-GRIFFIN
Suffix:
Gender:F
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 TIBURON WAY
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71909-6630
Mailing Address - Country:US
Mailing Address - Phone:501-276-3461
Mailing Address - Fax:
Practice Address - Street 1:6 TIBURON WAY
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909-6630
Practice Address - Country:US
Practice Address - Phone:501-276-3461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1257-C1041C0700X
TX20358 (INACTIVE)1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1257-COtherSTATE OF ARKANSAS SOCIAL WORK LICENSING BOARD
TX20358 (INACTIVE)OtherTEXAS STATE BOARD OF SOCIAL WORK EXAMINERS
AR1257-COtherSTATE OF ARKANSAS SOCIAL WORK LICENSING BOARD